Family influences on oral PrEP use among adolescent girls and young women in Kenya and South Africa
Outcomes: Human Immunodeficiency Virus
View SourceKey Social Norms Take-aways This study highlights the deep role of family—particularly mothers—in shaping adolescent girls’ and young women’s decisions around pre-exposure prophylaxis (PrEP) for HIV prevention. Though the study does not directly measure social norms, it provides insight into prevailing normative expectations about sexual behavior and health decision-making. Many young women feared judgment or stigma from family members, revealing norms around sexual silence, especially for unmarried adolescents. Disclosure of PrEP use was often viewed as an admission of sexual activity, which clashed with expectations of sexual abstinence. However, family support, especially from mothers, became a powerful enabler when aligned with accurate knowledge about PrEP and its purpose. The study underscores that family norms—both supportive and stigmatizing—can critically influence health behaviors, and that PrEP programs should equip adolescents with tools to navigate disclosure within these normative contexts.
Objectives To explore how family dynamics influence adolescent girls’ and young women’s initiation and continued use of oral PrEP in South Africa and Kenya, and to identify specific forms of family support or opposition that shape their HIV prevention journeys.
Methods This qualitative study was embedded in the broader Prevention Options for Women Evaluation Research (POWER) demonstration project and included in-depth interviews (n = 104) and focus group discussions (n = 33) with adolescent girls and young women aged 16–25 in Johannesburg, Cape Town, and Kisumu. Participants were selected across PrEP user categories (e.g., acceptors, refusers, persisters, restarters). Data were coded using thematic analysis with a focus on family-related influences across the stages of PrEP decision-making and persistence.
Intervention Details The study was part of the multi-country POWER project, which evaluated oral PrEP delivery to adolescent girls and young women in public health clinics in South Africa and Kenya. PrEP was integrated into routine sexual and reproductive health services. While clinical and counseling support was provided, no formal family engagement strategy was included. This allowed researchers to explore how participants navigated disclosure and family responses in naturalistic settings.
Results Mothers were central figures in either supporting or challenging PrEP use. Their involvement ranged from encouragement and reminders to disapproval based on misinformation. Disclosure was often a turning point for continued PrEP use, while non-disclosure created barriers to adherence.
Conclusions Families, especially mothers, can either support or hinder PrEP use. Raising awareness and reducing stigma at the family level may enhance adolescent girls’ and young women’s ability to consistently use HIV prevention tools.
Norms Addressed
Human Immunodeficiency Virus Disclaimer: These summaries were generated with the assistance of artificial intelligence and are based on the interpretation of source documents. While efforts have been made to ensure accuracy and clarity, there may be errors or omissions. Users are encouraged to consult the original documents for complete and authoritative information.